Provider Demographics
NPI:1891892493
Name:REGIONAL MRI OF JACKSONVILLE
Entity Type:Organization
Organization Name:REGIONAL MRI OF JACKSONVILLE
Other - Org Name:FIRST CHOICE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-455-7127
Mailing Address - Street 1:PO BOX 201672
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1672
Mailing Address - Country:US
Mailing Address - Phone:904-260-2805
Mailing Address - Fax:
Practice Address - Street 1:9872 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-260-2805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2688OtherBCBS
7012498OtherAETNA
7012498OtherAETNA